The patient, 74-year-old Thomas D'Amato, of New Milford, died three days after the procedure.

Dr. Michael Waldman, of Northeast Radiology, is facing possible revocation of his license because of the April 26, 2010, procedure, according to state Department of Public Health documents.

Department of Public Health records indicate Waldman followed standard New Milford Hospital practice for a "routine" thoracentesis, which is the insertion of a needle to remove fluid from the pleural space near a lung.

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However, the investigation determined the thoracentesis done on D'Amato was "not routine" and further precautions should have been taken after D'Amato's spleen was nicked, the DPH documents state.

Waldman was found to have "immediately recognized that he had perforated the spleen" of the patient, but sent him home without telling him, the investigation found.

The investigation found Waldman "never examined the patient and/or called any consulting physician prior to the patient being discharged." Waldman left to perform another procedure, documents state.

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New rule in place
New Milford Hospital now requires the transfer of a patient to the emergency department if complications from a procedure require urgent medical treatment.
source: Investigative report, State Department of Public Health, April 7, 2011

A follow-up chest X-ray was done, and the patient was kept in the radiology department for one hour with his vital signs monitored by radiology staff. D'Amato was then discharged with instructions for after care at home, according to the report.

He returned to the hospital emergency room "six hours later," the documents state, with shortness of breath and severe abdominal pains. A CT scan dated April 27 revealed he was hemorrhaging, likely from the spleen, and D'Amato was transferred to Danbury Hospital, were he died April 29, according to the investigative report.

D'Amato's widow, Diane D'Amato, has hired an attorney, John Houlihan Jr., of RisCassi & Davis, who is reviewing health department and New Milford Hospital documents to decide what action to take.

"We are sorry for the loss this family experienced and saddened by the outcome," said Deborah Weymouth, executive director and senior vice president of New Milford Hospital.

"It has been some time since this event took place but time does not always erase the impact of a loss," Weymouth added

Waldman believes he conducted the procedure and discharge correctly, his attorney, Jack D. Garamella, wrote in a Dec. 14 response to allegations he sent to the Department of Public Health.

"The patient was completely asymptomatic when discharged," Garamella wrote.

Waldman also believed the radiology department "was fully capable of performing the monitoring tasks. There was a nurse present at all times checking the patient," Garamella wrote.

Medical investigators interviewed two registered nurses about the incident: Kamala Basdeo and Linda Zaleta. The investigation determined that the responsibility of monitoring D'Amato was passed from Basdeo to Zaleta at a shift change.

Zaleta told the investigator she was not told about a possible injury to D'Amato's spleen when she began her shift, according to the investigator's June 2, 2010, survey notes worksheet.

Zaleta, in turn, "left to assist with another procedure, and a radiology technician monitored (D'Amato's) vital signs." Zaleta then returned to discharge D'Amato, the investigator's summary continues.

Since this incident, New Milford Hospital has put in place a strict protocol requiring imaging studies prior to any thoracentesis procedure. Waldman helped develop the protocol, according to the April 7, 2011, investigative report.

The hospital now also requires that a patient be transferred to the emergency department if complications require urgent medical treatment, according to the report.

Weymouth said Monday that since assuming her role as executive director at the hospital, she has come to appreciate the dedication to patient care by the staff.

"Our mission, and culture of continuous quality improvement remains focused on providing the best quality, patient-centered care," Weymouth said. "I am proud to say that our team believes in this mission and the responsibility it brings."

Waldman had reached a settlement with Department of Public Health attorneys concerning the April 2010 incident. He was to be placed on supervised probation for a year, according to proposed consent order documents.

Waldman did not admit to allegations of negligence in the incident, but he agreed not to contest the department investigator's findings.

But the state Medical Examining Board rejected that settlement, requiring a stronger sanction, its meeting minutes of Aug. 16 reveal.

A hearing into the case is possible, if Waldman's and health department lawyers do not reach an agreement acceptable to the board, department spokesman Diana Lejardi said last month.